Maternity and Pediatric Nursing
Chapter 40
Nursing Care of the Child With a
Cardiovascular Disorder
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Variations in Pediatric Anatomy
and Physiology
• Circulatory Changes from Gestation to Birth
• Structural and Functional Differences
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Common Medical Treatments
• A variety of medications as well as other medical
treatments and surgical procedures are used to
treat cardiovascular problems in children (see
Common Medical Treatments 40-1 and Drug Guide
40-1).
• Physician’s order is necessary for most of these
treatments when the child is in the hospital.
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Nursing Process Overview for the Child
with a Cardiovascular Disorder
• Assessment
– Health History (see Table 40-1)
• History of Present Illness
• Past Medical History
– Physical Examination
• Inspection
• Palpation
• Auscultation
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Nursing Process Overview (cont’d)
• Assessment (cont’d)
– Laboratory and Diagnostic Testing (see Common
Laboratory and Diagnostic Tests 40-1)
– Cardiac Catheterization
• Procedure (right-side, left-side)
• Nursing Management (before and after
procedure; see Teaching Guideline 40-1)
• Nursing Diagnoses and Related Interventions (see
Nursing Care Plan 40-1)
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Question
Is the following statement True or False?
For a right-sided catheterization, the catheter is
threaded to the right atrium.
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Answer
True.
In a right-sided catheterization, the radiopaque
catheter is inserted to the right atrium.
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Congenital Heart Disease
• Pathophysiology
• Categories
– Disorders with decreased pulmonary blood flow
(tetralogy of Fallot; tricuspid atresia)
– Disorders with increased pulmonary blood flow
(PDA, ASD, VSD, ACD)
– Obstructive disorders (coarctation of aorta,
aortic stenosis, pulmonary stenosis)
– Mixed disorders (TGV, TAPVR, hypoplastic left
heart syndrome)
• Therapeutic Management (see Table 40-2)
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Question
The nurse would identify which congenital heart
disease as involving increased pulmonary blood
flow?
A. Triscupid atresia
B. Patent ductus arteriosus
C. Tetralogy of Fallot
D. Aortic stenosis
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Answer
B.
Patent ductus arteriosus is a congenital heart disease
that involves increased pulmonary blood flow.
Tricuspid atresia and tetralogy of Fallot are disorders
involving decreased pulmonary blood flow. Aortic
stenosis is an obstructive disorder.
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Disorders with Decreased Pulmonary Blood
Flow
• Tetralogy of Fallot
– Pathophysiology
– Nursing Assessment
• Health History and Physical Examination
• Laboratory and Diagnostic Tests
• Tricuspid Atresia (see Figure 40-3)
– Pathophysiology
– Nursing Assessment
• Health History and Physical Examination
• Laboratory and Diagnostic Tests
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Disorders with Increased Pulmonary Flow
• Atrial Septal Defect (see Figure 40-4)
– Pathophysiology
– Nursing Assessment
• Ventricular Septal Defect (see Figure 40-5)
– Pathophysiology
– Nursing Assessment
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Disorders with Increased Pulmonary Flow
(cont’d)
• Atrrioventricular Canal Defect (see Figure 40-6)
– Pathophysiology
– Nursing Assessment
• Patent Ductus Arteriosus (see Figure 40-7)
– Pathophysiology
– Nursing Assessment
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Obstructive Disorders
• Coarctation of the Aorta (see Figure 40-8)
– Pathophysiology
– Nursing Assessment
• Aortic Stenosis (See Figure 40-9)
– Pathophysiology
– Nursing Assessment
• Pulmonary Stenosis (see Figure 40-10)
– Pathophysiology
– Nursing Assessment
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Mixed Defects
• Transposition of the Great Vessels (see Figure 40-11)
– Pathophysiology
– Nursing Assessment
• Total Anomalous Pulmonary Venous Connection (TAPVC;
see figure 40-12)
– Pathophysiology
– Nursing Assessment
• Truncus Arteriosus (see Figure 40-13)
– Pathophysiology
– Nursing Assessment
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Mixed Defects (cont’d)
• Hypoplastic Left Heart Syndrome (HLHS; see Figure
40-14)
– Pathophysiology
– Nursing Assessment
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Nursing Management of the Child with CHD
• Improving Oxygenation (see Box 40-1)
• Promoting Adequate Nutrition
• Assisting the Child and Family to Cope
• Preventing Infection
• Providing Care for the Child Undergoing Cardiac
Surgery
– Providing Preoperative Care
– Providing Postoperative Care (see Box 40-2)
• Providing Patient and Family Education (see
Teaching Guidelines 40-2)
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Question
A child with CHD experiences hypercyanotic spells.
The nurse would place the child in which position
for relief?
A. Supine
B. Trendelenburg
C. Knee-to-chest
D. Prone
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Answer
C.
To relieve hypercyanotic spells, the child should be
placed in the knee-to-chest position.
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Acquired Cardiovascular Disorders
• Heart failure
• Infective endocarditis
• Acute rheumatic fever
• Cardiomyopathy
• Hypertension
• Kawasaki disease
• Hyperlipidemia
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Heart Failure
• Pathophysiology (see Figure 40-15)
• Therapeutic Management: supportive; drug therapy
(digitalis, diuretics, inotropic agents, vasodilators,
antiarrhythmics, and antithrombotics)
• Nursing Assessment
– Health History
– Physical Examination
– Laboratory and Diagnostic Tests
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Heart Failure (cont’d)
• Nursing Management
– Promoting Oxygenation
– Supporting Cardiac Function
– Providing Adequate Nutrition
– Promoting Rest
– Educating the Child and Family
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Infective Endocarditis
• Therapeutic Management (antibiotic or antifungal
therapy
• Nursing Assessment
– Health History
– Physical Examination
• Nursing Management (see Box 40-3)
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Acute Rheumatic Fever
• Diagnosis using modified Jones’ criteria (see Box 404)
• Therapeutic Management: managing inflammation
and fever, eradicating bacteria, preventing
permanent heart damage, preventing recurrences
• Nursing Assessment
• Nursing Management
– Compliance with therapy
– Prophylaxis
– Child and family education
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Question
Is the following statement True or False?
The diagnosis of acute rheumatic fever requires
evidence of a positive culture for streptococcus.
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Answer
False.
The diagnosis of acute rheumatic fever is based on
the modified Jones’ criteria; this requires the
presence of either two major criteria or one major
plus two minor criteria, none of which is a positive
streptococcal culture.
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Cardiomyopathy
• 3 types: restrictive, dilated, hypertrophic
• Therapeutic Management: improvement of heart
function and blood pressure (mechanical ventilation,
vasoactive medications, pacemakers, or surgery)
• Nursing Assessment
• Nursing Management
– Monitoring for complications
– Medication administration
– Child and family support and education
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Hypertension
• Pathophysiology
• Nursing Assessment
– Health History: risk factors, signs and symptoms
– Physical Examination: inspection, auscultation
– Laboratory and Diagnostic Testing
• Nursing Management
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Kawasaki Disease
• Pathophysiology
• Therapeutic Management
• Nursing Assessment
– Health History and Physical Examination
– Laboratory and Diagnostic Testing
• Nursing Management
– Monitoring Cardiac Status
– Promoting Comfort
– Providing Patient and Family Education
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Hyperlipidemia
• Pathophysiology
• Therapeutic Management
• Nursing Assessment
– Health History and Physical Examination
– Lipid Levels (see Table 40-3)
• Nursing Management
– Diet
– Physical Activity
– Medications
– EducationCopyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Heart Transplantation
• Indications
• Candidates and Evaluation
• Surgical Procedure and Postoperative Therapeutic
Management
• Nursing Management
– Preoperative care
– Postoperative care
– Patient and family education
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End of Presentation
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